Long-term effectiveness of a nurse-led smoking cessation clinic at a comprehensive cancer center.

PURPOSE: Smoking cessation interventions should be promoted in cancer centers to improve clinical outcomes among cancer patients and the quality of life of cancer-free patients and survivors. The aim of the present study was to examine long-term abstinence (1, 3, and 5 years) among smokers who received an intensive nurse-led smoking cessation intervention. DESIGN: A prospective follow-up study was conducted in a smoking cessation clinic in Barcelona. METHODS: The study included 479 smokers who received a nurse-led smoking cessation intervention that included motivational interviewing, psychological support, behavioral change counseling, promotion of smoke-free policies, and relapse-prevention strategies, as well as pharmacotherapy if necessary, for 12 months. We calculated overall and sex-specific 1-, 3-, and 5-year abstinence probabilities (Kaplan-Meier curves) and adjusted hazard ratios (aHRs) of relapse with 95% confidence intervals (CIs) using Cox regression. FINDINGS: The overall probability of abstinence at 1 and 5 years was 0.561 (95% CI: 0.516-0.606) and 0.364 (95% CI: 0.311-0.417), respectively. Females had a higher, but not significant, hazard ratio for relapse compared to males (aHR = 1.180; 95% CI: 0.905-1.538). Attending <5 visits was the most remarkable determinant of relapsing compared to attending 5-9 visits or ≥10 visits, both overall and by sex (p for trend: overall, p < 0.001; males, p = 0.007; and females, p < 0.001). CONCLUSIONS: Abstinence probability decreased over the 5-year follow-up but was relatively high. Males had higher abstinence rates than females in all follow-up periods. Completeness of the intensive intervention was the main predictor of cessation. CLINICAL RELEVANCE: Smoking cessation interventions should consider sex and incorporate strategies to increase adherence to obtain higher long-term abstinence rates.

Second-hand smoke exposure in indoor and outdoor areas of cafés and restaurants: Need for extending smoking regulation outdoors?

Smoke-free legislation in indoor public places has concentrated smokers in the areas outside building entrances or other outdoor areas. This study assessed the drift of second-hand smoke between outdoor and indoor areas of cafés and restaurants in Barcelona, Spain, and characterized the exposure on outdoor terraces. Using a cross-sectional design, we monitored vapor-phase nicotine in indoor areas and outside entrances simultaneously (n=47), and on some outdoor terraces (n=51). We computed the median nicotine concentration and interquartile range (IQR) to describe the data and performed multivariate analysis to describe nicotine concentration and its determinants. The overall median nicotine concentration indoors was 0.65µg/m(3) (IQR: 0.29-1.17µg/m(3)), with significant differences based on the number of smokers at the entrance (p=0.039). At outside entrances, the overall median nicotine concentration was 0.41µg/m(3) (IQR: 0.21-1.17µg/m(3)). The nicotine concentrations indoors and at the corresponding outside entrances were not significantly different, and the multivariate analysis confirmed the relationship between these variables. On terraces, the overall median nicotine concentration was 0.54µg/m(3) (IQR: 0.25-1.14µg/m(3)), but it increased to 0.60µg/m(3) when a tobacco smell was perceived, 0.72µg/m(3) on closed terraces, 1.24µg/m(3) when there were >6 smokers, and 1.24µg/m(3) when someone smoked >20min. Multivariate analysis confirmed the outdoor terrace area, the season, the type of enclosure, and the number of smokers as the most relevant variables explaining nicotine concentration (R(2)=0.396). These findings show that second-hand smoke exposure exists in indoor areas due to smokers smoking at the outside entrances. In addition, exposure may occur on outdoor terraces when smokers are present and the terrace is enclosed to some extent. Thus, the current Spanish law does not fully protect non-smokers from second-hand smoke and supports extending regulation to some outdoor areas.

Impact of a long-term tobacco-free policy at a comprehensive cancer center: a series of cross-sectional surveys.

BACKGROUND: Spain has passed two smoke-free laws in the last years. In 2005, the law banned smoking in indoor places, and in 2010 the ban was extended to outdoor areas of certain premises such as hospitals. This study assesses the impact of smoking consumption among hospital workers at a comprehensive cancer center after the passage of two national smoke-free laws. METHODS: Six cross-sectional surveys were conducted among a representative sample of hospital workers at a comprehensive cancer center in Barcelona (2001-2012) using a standardized questionnaire. Logistic regression was used to compare differences in the odds of smoking after the laws took effect (baseline vs. 1st law; 2nd law vs. 1st law). RESULTS: Baseline smoking prevalence was 33.1%. After passage of the 1st and 2nd laws, prevalence decreased, respectively, to 30.5% and 22.2% (p for trend =0.005). Prevalence ratios (PR) indicated a significant decrease in overall smoking after the 2nd law (PR = 0.65, 95% CI = 0.47-0-89). Smoking dropped in all professional groups, more prominently among those ≥35 years old, doctors, and women. Observed trends over the time included an increase in occasional smokers, a rise in abstinence during working hours but an increase in smoking dependence, and an increase in the employees' overall support for the smoke-free hospital project. CONCLUSIONS: A long-term tobacco control project combined with two smoke-free national laws reduced smoking rates among health workers and increased their support for tobacco control policies. The decrease was more significant after the passage of the outdoor smoke-free ban.

Measuring cigarette dependence: A comparison of two scales in two different groups of smokers.

INTRODUCTION: The Fagerström Test for Cigarette Dependence (FTCD) and the Cigarette Dependence Scale (CDS) are usually used to assess cigarette dependence in clinical- and population-based studies. Our objective was to compare these two scales within groups of smokers from both contexts. METHODS: The study was observational with smokers from a representative sample of the adult general population (n=188) and smokers attending a smoking cessation clinic in Barcelona, Spain (n=759). The FTCD and the CDS-5 (short version of 5 items) were used to assess cigarette dependence. We compared the standardized median scores obtained with both scales within each group of smokers by selected variables. To this aim, we re-scaled the scores of both scales to allow their comparison and assess their correlation within both groups. RESULTS: The scores obtained with both scales were highly correlated within both groups of smokers (p<0.001), indicating good agreement in the assessment of cigarette dependence. Nevertheless, higher standardized CDS-5 scores were observed more frequently in the population group overall (3.9 vs FTCD score=3.7, p=0.001), among women (4.5 vs 4.2; p<0.001), in the youngest group of smokers (3.9 vs 3.2; p<0.007) and in light smokers (time to the first cigarette >60 min; 1.7 vs 1.1; p<0.001). CONCLUSIONS: While the CDS-5 scored higher more frequently in the population group, the FTCD scored higher more frequently in the clinical group. These differences should be considered when designing either clinical- or population-based studies.

Patient perceptions of tobacco control after smoke-free hospital grounds legislation: Multi-center cross-sectional study.

OBJECTIVE: To examine patient perceptions of the role of health care providers in tobacco control and tobacco-related services they should provide after the introduction of national smoke-free hospital grounds legislation in Spain. DESIGN: Multi-center cross-sectional study. SETTING: Thirteen hospitals in Barcelona province in 2014-2015. PARTICIPANTS: A total of 1,047 adult hospital patients, with a stay ≥ 24 h were randomly selected. METHOD: We explored participants' perceptions of the role of health professionals and hospitals in tobacco control by asking about their agreement with several statements after the introduction of national legislation on smoke-free hospital grounds: (i) health professionals "should set an example and not smoke" and "should provide smoking cessation support"; (ii) hospitals "should provide smoking cessation treatments" and are "role model organizations in compliance with the smoke-free legislation", and (iii) "hospitalization is a perfect moment to quit smoking". Responses were described overall and according to participant and hospital characteristics: patient sex and age, type of hospital unit, number of beds, and smoking prevalence among hospital staff. RESULTS: The majority of participants considered that health professionals should be role models in tobacco cessation (75.3%), should provide smoking cessation support to patients (83.0%), and that hospitalization is a good opportunity for initiating an attempt to quit (71.5%). Inpatients admitted to general hospitals where smoking cessation was not given as part of their portfolio, with a low level of implementation in tobacco control, and who stayed in surgical units had higher expectations of receiving smoking cessation interventions. CONCLUSIONS: Inpatients strongly support the role of hospitals and health professionals in tobacco control and expect to receive smoking cessation interventions during their hospital stay. Systematically providing smoking cessation services in hospitals may have a relevant impact on health outcomes among smokers and on health care system expenditures.

Smoking among hospitalized patients: A multi-hospital cross-sectional study of a widely neglected problem.

INTRODUCTION: A comprehensive smoking ban was recently enacted for acute-care hospital campuses in Spain. The aim of this study was to assess the prevalence and patterns of smoking among inpatients before and during hospitalization. METHODS: Multi-center cross-sectional study was conducted in 13 hospitals in the province of Barcelona, Spain from May 2014 to May 2015. Participants were adults who provided informed consent. The sample size was calculated to be representative of each hospital (prevalence 29.4%, precision ± 5%, error 5%). We approached 1228 subjects, 888 accepted to participate and 170 were replaced (were not available or declined to participate). Final sample comprised 1047 subjects. We used a computer-assisted personal interview system to collect data, including sociodemographic variables and use of tobacco before and during hospitalization. Smoking status was validated with exhaled carbon monoxide. We calculated overall tobacco prevalence and investigated associations with participant and center characteristics. We performed multiple polytomous and multilevel logistic regression analyses to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with adjustments for potential confounders. RESULTS: In all, 20.5% (95% CI: 18.1-23.0) of hospitalized patients were smokers. Smoking was most common among men (aOR=7.47; 95% CI: 4.88-11.43), young age groups (18-64 years), and individuals with primary or less than primary education (aOR=2.76; 95% CI: 1.44-5.28). Of the smokers, 97.2% were daily consumers of whom 44.9% had medium nicotine dependence. Of all smokers, three-quarters expressed a wish to quit, and one-quarter admitted to consuming tobacco during hospitalization. CONCLUSIONS: Our findings indicate the need to offer smoking cessation interventions among hospitalized patients in all units and service areas, to avoid infringements and increase patient safety, hospital efficiency, and improve clinical outcomes. Hospitalization represents a promising window for initiating smoking interventions addressed to all patients admitted to smoke-free hospitals, specially after applying a smoke-free campus ban.

[Smoking prevalence in hospital workers: meta-analysis in 45 Catalan hospitals]. / Prevalencia de consumo de tabaco en trabajadores hospitalarios: metaanálisis en 45 hospitales catalanes.

OBJECTIVE: To estimate the prevalence of smoking in workers from hospitals within the Catalan Network for Smoke-free hospitals from 2009 to 2012 according to workers' sociodemographic characteristics and the type of hospital. METHOD: A meta-analysis was performed of prevalence surveys from representative samples of workers from 45 hospitals. The combined prevalence for all hospitals was calculated using a regression model with a random effects model weighted by sample size. RESULTS: The overall prevalence of smoking was 28.1% (95%CI: 26.1 to 30.0%) with a maximum and minimum of 40.3% and 19.1%, respectively. The health professionals with the lowest prevalence of smoking were physicians (16.4%; 95%CI: 12.9 to 19.9) and nurses (25.4%; 95%CI 21.6 to 29.2). CONCLUSION: The prevalence of smoking in hospital health workers was lower than in the general population of working age. Physicians were the group with the lowest smoking prevalence. Smoking cessation should be promoted among other professional groups.

Maintenance of tobacco cessation programmes in public hospitals in Catalonia, Spain.

INTRODUCTION: The provision of smoking cessation interventions in hospitals has been strongly recommended. The aim of this study is to determine the maintenance of smoking cessation programmes for inpatients and hospital workers in hospitals of Catalonia (Spain) seven years after the implementation of a Tobacco Cessation Programme. METHODS: A cross-sectional survey was conducted in all hospitals that offer public service in Catalonia, Spain (n=73). An online questionnaire was sent to all coordinators of the smoke-free hospital project or managers of each hospital. The survey included questions about the type of hospital, type of programmes implemented and availability and source of smoking cessation drugs. RESULTS: Responses to the questionnaire were submitted by 58 hospitals (79.5%). 74% and 93.1% of the hospitals had smoking cessation programmes for inpatients and workers, respectively. Most of the hospitals maintained the programmes and started routinely buying smoking cessation drugs after a period of receiving them free-of-charge. However, 17.2% of the hospitals refused to buy these drugs and 24% never had these drugs available. CONCLUSIONS: Through a supportive Tobacco Cessation Programme, most hospitals have smoking cessation programmes for both patients and workers. Most of them have incorporated smoking cessation drugs as a regular resource in their services' portfolio. The lack of these resources may jeopardise the maintenance of well-established programmes in hospitals.

[Feasibility of following up a representative sample of the adult population in Barcelona (Spain)]. / Factibilidad del seguimiento de una muestra representativa de la población adulta de la ciudad de Barcelona.

The objective of this work was to study the feasibility of following up a representative sample of the adult population of Barcelona 8 years after the baseline study. We selected a random sample (n=100) of the 1161 participants who consented to be re-contacted. We contacted 66 participants: 52 (78.8%) agreed to participate in the follow-up, three (4.5%) had died, four (6.1%) had moved, and seven (10.6%) declined to participate in the follow-up. The participation rate in the feasibility study was 52%. In conclusion, the results of our study show a good feasibility of conducting a follow-up study 8 years after the baseline study.

Prevalencia de consumo de tabaco en trabajadores hospitalarios: metaanálisis en 45 hospitales catalanes / Smoking prevalence in hospital workers: meta-analysis in 45 Catalan hospitals

Objetivo: Estimar la prevalencia de consumo de tabaco en trabajadores/as de los hospitales miembros de la Red Catalana de Hospitales sin Humo según sus características sociodemográficas y tipo de hospital al que pertenecen, en el período 2009-2012. Método: Metaanálisis de encuestas de prevalencia en muestras representativas de trabajadores/as de 45 hospitales (2009-2012). La prevalencia conjunta se calculó mediante un modelo de regresión con efectos aleatorios ponderado por el tamaño muestral. Resultados: La prevalencia global de consumo de tabaco es del 28,1% (intervalo de confianza del 95% [IC95%]: 26,1-30,0%), con valores máximos y mínimos del 40,3% y el 19,1%. Los grupos con menor prevalencia son el colectivo médico (16,4%; IC95%: 12,9-19,9%) y el colectivo de enfermería (25,4%; IC95%: 21,6-29,2%). Conclusión La prevalencia de consumo de tabaco en trabajadores/as hospitalarios/as es menor que en la población general en edad laboral, siendo el colectivo médico el menos fumador. Es necesario implementar acciones que faciliten el abandono del tabaco en el resto de los colectivos (AU)

Objective: To estimate the prevalence of smoking in workers from hospitals within the Catalan Network for Smoke-free hospitals from 2009 to 2012 according to workers’ sociodemographic characteristics and the type of hospital. Method: A meta-analysis was performed of prevalence surveys from representative samples of workers from 45 hospitals. The combined prevalence for all hospitals was calculated using a regression model with a random effects model weighted by sample size. Results: The overall prevalence of smoking was 28.1% (95%CI: 26.1 to 30.0%) with a maximum and minimum of 40.3% and 19.1%, respectively. The health professionals with the lowest prevalence of smoking were physicians (16.4%; 95%CI: 12.9 to 19.9) and nurses (25.4%; 95%CI 21.6 to 29.2). Conclusion: The prevalence of smoking in hospital health workers was lower than in the general population of working age. Physicians were the group with the lowest smoking prevalence. Smoking cessation should be promoted among other professional groups (AU)

Factibilidad del seguimiento de una muestra representativa de la población adulta de la ciudad de Barcelona / Feasibility of following up a representative sample of the adult population in Barcelona (Spain)

El objetivo de este trabajo es estudiar la factibilidad del seguimiento de una muestra representativa de la población adulta de Barcelona 8 años después del estudio basal. Se seleccionó una muestra aleatoria (n = 100) de los 1161 participantes que dieron su consentimiento para volver a contactar con ellos. Se logró contactar con 66 de los participantes: 52 (78,8%) accedieron a participar en el estudio de seguimiento, 3 (4,5%) habían fallecido, 4 (6,1%) habían cambiado de domicilio y 7 (10,6%) declinaron participar en el seguimiento. La tasa de participación en el estudio de factibilidad fue del 52%. En conclusión, los resultados de nuestro estudio muestran una alta factibilidad de realizar un seguimiento 8 años después del estudio basal (AU)

The objective of this work was to study the feasibility of following up a representative sample of the adult population of Barcelona 8 years after the baseline study. We selected a random sample (n = 100) of the 1161 participants who consented to be re-contacted. We contacted 66 participants: 52 (78.8%) agreed to participate in the follow-up, three (4.5%) had died, four (6.1%) had moved, and seven (10.6%) declined to participate in the follow-up. The participation rate in the feasibility study was 52%. In conclusion, the results of our study show a good feasibility of conducting a follow-up study 8 years after the baseline study (AU)